Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race

Cooper, Lisa A.; Roter, Debra; Johnson, Rachel L.; Ford, Daniel E.; Steinwachs, Donald M.; Powe, Neil R.

doi:10.7326/0003-4819-139-11-200312020-00009

Cited by 1,071 publications

(825 citation statements)

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“…In this study, as in other studies that used the RIAS system, patient-centered communication was operationalized as proportionately greater engagement by the patient in information seeking and disclosure in the psychosocial and socioemotional dimensions of illness management than in biomedically focused dialogue about disease management (14,15). The patient-centeredness ratio was calculated as the number of patient-centered statements divided by the number of medically focused and directive statements.…”

Section: Methodsmentioning

confidence: 99%

A Web-Based Program to Empower Patients Who Have Schizophrenia to Discuss Quality of Care With Mental Health Providers

Steinwachs¹,

Roter²,

Skinner³

et al. 2011

Psychiatric Services

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Objective This study evaluated a Web-based tool to help patients with schizophrenia communicate with clinicians about evidence-based treatments. Methods Fifty patients used an interactive Web-based intervention featuring video clips of actors simulating a patient discussing treatment concerns (intervention group; N=24) or were shown an educational video about schizophrenia treatment before a routine follow-up appointment (control group; N=26). The visits were recorded and analyzed by using the Roter Interaction Analysis System. Results Intervention group visits were longer (24 versus 19 minutes, p<.05) and had a proportionately greater patient contribution to the dialogue (288 versus 229 statements, p<.05) and less verbal dominance by clinicians (ratio of clinician to patient talk of 1.1 versus 1.4, p<.05) compared with control group visits. Intervention group patients asked more questions about treatment (2 versus .9, p<.05), disclosed more lifestyle information (76 versus 53 statements, p<.005) and more often checked that they understood information (3.6 versus 2.1 checks, p<.05). Clinicians asked more questions about treatment (7.5 versus 5.1, p<.05) and the medical condition (7.8 versus 4.7, p<.05) to control group patients but with intervention group patients were more patient-centered overall (8.5 versus 3.2, p<.05) and made more statements of empathy (1.3 versus 0.4, p<.03) and cues of interest (48 versus 22, p<.05). The emotional tone of intervention relative to control visits was rated as more dominant and respectful for patients (p<.05) and more sympathetic for clinicians (p<.05). Conclusions The Web-based tool empowered persons with schizophrenia to engage more fully in a patient centered dialogue about their treatment.

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Section: Methodsmentioning

confidence: 99%

A Web-Based Program to Empower Patients Who Have Schizophrenia to Discuss Quality of Care With Mental Health Providers

Steinwachs¹,

Roter²,

Skinner³

et al. 2011

Psychiatric Services

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“…However, the influence of any one variable (e.g., ethnicity) may vary depending on the presence of other factors (e.g., the patient's level of education, the physicians' communication style). While some studies have examined multiple variables (Cooper, Roter, Johnson, Ford, Steinwachs & Powe, 2003;Siminoff, Graham & Gordon, 2006), little attention has been given to the processes by which these factors may have influence. In contrast, an ecological approach recognizes that within the context of any medical encounter, a number of processes affect the way physicians and patients communicate and perceive one another.…”

Section: Conceptual Framework: An Ecological Approachmentioning

confidence: 99%

“…Such findings have led some to explore whether demographic concordance between physician and patient may facilitate better relationships and more positive health care interactions because the physician and patient have some element of shared identity. Some evidence supports this claim, particularly with regard to racial concordance (Cooper et al, 2003;Cooper-Patrick, Gallo, Gonzales, Vu, Powe, Nelson et al 1999;LaVeist & Nuru-Jeter, 2002;Saha, Komaromy, Koepsell & Bindman, 1999). Although there is little evidence indicating that physicians provide better care to patients similar in age or gender, we nevertheless examined whether differences in physicians' communication and perceptions are uniquely related to physician-patient concordance with respect to race, age, and gender (see Figure 1).…”

Section: Conceptual Framework: An Ecological Approachmentioning

confidence: 99%

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Street

Gordon

Haidet

2007

Social Science & Medicine

434

356

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Although physicians' communication style and perceptions affect outcomes, few studies have examined how these perceptions relate to the way physicians communicate with patients. Moreover, while any number of factors may affect the communication process, few studies have analyzed these effects collectively in order to identify the most powerful influences on physician communication and perceptions. Adopting an ecological approach, this investigation examined: (a) the relationships of physicians' patient-centered communication (informative, supportive, partnership-building) and affect (positive, contentious) on their perceptions of the patient, and (b) the degree to which communication and perceptions were affected by the physicians' characteristics, patients' demographic characteristics, physician-patient concordance, and the patient's communication. Physicians (N = 29) and patients (N = 207) from 10 outpatient settings in the United States participated in the study. From audio-recordings of these visits, coders rated the physicians' communication and affect as well as the patients' participation and affect. Doctors were more patientcentered with patients they perceived as better communicators, more satisfied, and more likely to adhere. Physicians displayed more patient-centered communication and more favorably perceived patients who expressed positive affect, were more involved, and who were less contentious. Physicians were more contentious with black patients, whom they also perceived as less effective communicators and less satisfied. Finally, physicians who reported a patient-centered orientation to the doctor-patient relationship also were more patient-centered in their communication. The results suggest that reciprocity and mutual influence have a strong effect on these interactions in that more positive (or negative) communication from one participant leads to similar responses from the other. Physicians' encounters with black patients revealed communicative difficulties that may lower quality of care for these patients.

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“…Prior studies indicate that African-American older adults have lower rates of depression diagnoses in clinical settings than older white patients [21-24], and results from qualitative studies of mixed-age samples suggest that African-American patients may find antidepressant treatment less acceptable than white patients [25]. When African Americans do seek specialty mental health care, they have fewer appointments and are more likely than white patients to terminate treatment prematurely [26, 27].…”

Section: Introductionmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. While racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients. Design Prospective, observational study comparing antidepressant adherence for older African-American and white primary care patients. Participants One hundred and eighty-eight subjects aged 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician. Measurement Study participants were assessed at study entry and at four-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure. Results At four-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African-American subjects (n=82) had significantly lower rates of four-month antidepressant adherence than white subjects (n=106). African-American females had the lowest adherence rates (44.4%) followed by African-American males (56.8%), white males (65.3%) and white females (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African-American women and white women in reported four-month antidepressant adherence (OR 3.58, 95% CI 1.27-10.07, Wald Chi-square =2.42, df=1, p<0.02). Conclusions The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for the older adults should take into account the potential impact of race and gender on adherence to prescribed medications.

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Patient-Centered Communication, Ratings of Care, and Concordance of Patient and Physician Race

Cited by 1,071 publications

References 50 publications

A Web-Based Program to Empower Patients Who Have Schizophrenia to Discuss Quality of Care With Mental Health Providers

A Web-Based Program to Empower Patients Who Have Schizophrenia to Discuss Quality of Care With Mental Health Providers

Physicians’ communication and perceptions of patients: Is it how they look, how they talk, or is it just the doctor?

Racial Differences in Adherence to Antidepressant Treatment in Later Life

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